Individual
AMANDA J LIECHTY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
5857 ARGERIAN DR STE 102, WESLEY CHAPEL, FL 33545-4507
(813) 876-7073
(813) 877-1277
Mailing address
4927 VAN DYKE RD, LUTZ, FL 33558-4813
(813) 480-2892
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
MA058558
PA
363A00000X
Physician Assistant
Primary
PA9116134
FL
363A00000X
Physician Assistant
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1032657000001
—
PA
01
—
546523
MEDICARE
PA
Enumeration date
06/08/2015
Last updated
04/16/2025
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